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BMJ Sexual and Reproductive Health. 2018 Jan; 44(1):66-68.Following publication of the author's trial on the effects of postnatal depot medroxyprogesterone acetate (DMPA) compared with the copper intrauterine device (IUD) on postnatal depression in this journal in July 2016, they have sought to evaluate contraceptive discontinuation in our study sample. Postnatal contraception is promoted as part of the WHO strategy to reduce the unmet need for family planning in low- and middle-income countries (LMICs) and to reduce preventable maternal and child mortality. However, little is known about discontinuation rates associated with postnatal contraception use in these settings. From the trial, 75 of 242 participants were contactable two or more years after randomisation and 54 consented to a follow-up interview, which was conducted by a Masters student from the University of Fort Hare (NDY). Twenty-three women had received DMPA and 31 women an IUD. In the DMPA and IUD arms, respectively, 48% (11/23) and 42% (13/31) had discontinued their contraceptive methods by the time of the interview. All participants who discontinued did so within the first year, 10 within 3 months of allocation (DMPA=4, IUD=6), and 17 within 6 months (DMPA=7, IUD=10). Six of the participants allocated to DMPA (26%) and five allocated to the IUD (16%) became pregnant following discontinuation.
[Geneva, Switzerland], WHO, 2016 Feb.  p.Emergency contraception can prevent most pregnancies when taken after intercourse. Emergency contraception can be used in the following situations: unprotected intercourse, contraceptive failure, incorrect use of contraceptives, or in cases of sexual assault. There are 3 methods of emergency contraception: emergency contraceptive pills (ECPs), combined oral contraceptive pills or the Yuzpe method, and copper-bearing intrauterine devices (IUDs). A copper-bearing IUD is the most effective form of emergency contraception available when inserted within 5 days of unprotected intercourse. The emergency contraceptive pill regimen recommended by WHO is either: a. 1 dose of levonorgestrel 1.5 mg, or 1 dose of ulipristal 30 mg, taken within 5 days (120 hours) of unprotected intercourse; or b. 2 doses of combined oral contraceptive pills (also known as the Yuzpe regimen).
[Geneva, Switzerland], WHO, 2012 Jul.  p. (Fact Sheet No. 244)Emergency contraception can prevent most pregnancies when taken after intercourse. Emergency contraception can be used following unprotected intercourse, contraceptive failure, incorrect use of contraceptives, or in cases of sexual assault. There are two methods of emergency contraception: emergency contraceptive pills (ECPs) and copper-bearing intrauterine devices (IUDs). When inserted within five days of unprotected intercourse, a copper-bearing IUD is the most effective form of emergency contraception available. The emergency contraceptive pill regimen recommended by WHO is one dose of levonorgestrel 1.5 mg, taken within five days (120 hours) of unprotected intercourse.
Training and reference guide for a screening checklist to initiate use of the copper IUD. Second edition.
Research Triangle Park, North Carolina, Family Health International [FHI], 2009. 79 p. (USAID Cooperative Agreement No. GPO-A-00-05-00022-00)This training and reference guide was developed for family planning service providers interested in using the Checklist for Screening Clients Who Want to Initiate Use of the Copper IUD, commonly referred to as the "IUD Checklist." Designed to serve as both a training and reference tool, the guide is composed of two parts: a training module and a collection of essential, up-to-date reference materials on the copper intrauterine device (IUD). This guide is part of a series to train on other checklists. The IUD Checklist was developed to assist service providers in screening clients who have already been counseled about contraceptive options and who have made an informed decision to use the copper IUD. This simple job aid is based on the technical guidance provided by the World Health Organization (WHO) in its Medical Eligibility Criteria for Contraceptive Use (2004, updated 2008). The checklist supports the application of these guidelines -- known as the WHO MEC -- into service delivery practice. (Excerpts)
Nairobi, Kenya, Ministry of Health, 2004 Jun.  p. (IUCD Method Briefs Update)The World Health Organization (WHO) recently revised the guidelines for IUCD use as part of an update of its Medical Eligibility Criteria for Contraceptive Use (MEC). These revisions will improve quality of care and reduce medical barriers for women who are considering an IUCD as a contraceptive method. Based on the latest clinical and epidemiological research, the revisions are particularly significant for women at risk of sexually transmitted infections (STIs), including HIV, and women living with HIV or AIDS. Research has shown that while some conditions restrict IUCD initiation, they do not necessarily affect the safety of continued use. Under the new guidelines, for example, a client who has gonorrhea or chlamydial infection is considered a Category 4 for IUCD initiation and should be advised to choose another method. However, if an IUCD user develops an STI, she can be treated with antibiotics without the IUCD being removed (Category 2). In addition, the client should be counseled about partner notification and treatment, and condom use. (excerpt)
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 2-4. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)The 2003 Expert Working Group made several changes to the MEC to indicate that women often can safely use IUDs in conditions related to HIV and other sexually transmitted infections (STIs). Taken together, these changes should help reduce some providers’ concerns about offering IUDs in areas where HIV infection and other STIs are common. At the meeting the WHO Expert Working Group concluded that a woman generally can start using an IUD, if she wishes, even if she has AIDS—provided she is receiving ARV therapy and is clinically well—or if she has HIV infection or she is at high risk of HIV infection. The Expert Working Group changed these conditions from category 3 to category 2 for starting IUD use. According to the bulk of research considered at the WHO meeting, IUD use does not increase a woman’s chances of acquiring HIV infection. Women generally can keep their IUDs if they become infected with HIV or develop AIDS while using IUDs (category 2), although IUD users with AIDS should be carefully monitored for pelvic infection. Limited evidence shows that complications of IUD use are no more common among IUD users infected with HIV than among IUD users who are not infected with HIV. Also, IUD use does not increase HIV transmission to sexual partners. (excerpt)
[World Health Organization (WHO) eligibility criteria for oral contraceptive use. Part 2] Criterios de la OMS de elegibilidad para el uso de anticonceptivos(segunda parte).
BOLETIN INFORMATIVO. 1996 Nov-Dec; (26):4-9.New medical criteria for IUDs and barrier methods defined by the World Health Organization in 1995 to reflect development of safer methods are presented. Health conditions are classified into four categories. Category 2 conditions need not restrict use of a method but should be considered when a method is chosen. Category 3 conditions require careful consideration of the gravity of the case, the availability of alternative methods, and access to emergency services, as well as careful follow-up. Many conditions that had been considered contraindications to IUD use are no longer regarded as risk factors with copper IUDs. Use is unrestricted for women over 20, smokers, the obese, lactating women, those with a history of preeclampsia, ectopic pregnancy, epilepsy, diabetes, and many other conditions. Age under 20 and nulliparity are category 2 conditions because of the risk of expulsion. Severe menstrual bleeding, under 48 hours postpartum, uterine-cervical abnormalities not deforming the uterus, and a few other conditions are in category 2. Category 3 conditions in which risks outweigh advantages include 48 hours to 4 weeks postpartum, benign gestational trophoblastic disorders, elevated risk of HIV/AIDS or HIV infection. Category 4 conditions precluding use of IUDs include pregnancy; puerperal sepsis or septic abortion; uterine abnormality incompatible with insertion; vaginal bleeding of unknown cause; gestational trophoblastic malignancy; cervical, endometrial, or ovarian cancer; pelvic tuberculosis; and sexually transmitted disease within three months. Almost all conditions are in category 1 and none are in category 4 for use of barrier methods, but their relatively high failure rates should be kept in mind. Allergy to latex is a category 3 condition for condoms and diaphragms and history of toxic shock syndrome is a category 3 for diaphragms.
PROGRESS IN HUMAN REPRODUCTION RESEARCH. 1992; (22):2-3.The WHO Special Programme of Research, Development and Research Training in Human Reproduction has conducted long term studies on 2 copper releasing IUDs (TCu220C and TCu380A) in almost 2800 women which show that they are effective for 9 years. The pregnancy rates for TCu220C at 7 and 9 years are 4.9 and 5.4/1000 woman years respectively. Thus the annual risk of pregnancy is about 1%. The pregnancy rates for TCu380A are even lower (1.7 and 2.1 respectively), an annual rate of less than 0.5%. As a result of these studies, the US Food and Drug Administration sanctioned TCu380A use for 8 years up from 6 years. More than 80 million women worldwide, especially in developing countries (e.g., about 74 million in China), use the IUD. Researchers have analyzed data on 22,908 insertions from 12 trials to see whether IUD use is related to pelvic inflammatory disease (PID) and whether long term use causes more severe PID. They learned that the overall PID rate is 1.6/1000 woman years. The first 20 days after insertion carry a 7 times higher risk of PID, but the risk falls considerably thereafter and stays low for at least 8 years. Further, duration of IUD use does not increase the severity of PID. WHO is supporting research at 28 centers which are evaluating a new IUD which has copper sleeves hanging from a nylon suture (frameless IUD). During insertion, the clinician embeds the suture superficially into the top of the uterus so the IUD and the copper sleeves are suspended. WHO is also supporting research at up to 6 centers on 2 modified frameless IUDs designed to be inserted after delivery. The research want to determine whether the high expulsion rate of IUDs inserted during the postpartum period can be reduced.
PID risk for IUD users highest in first 20 days after insertion; risk then falls sharply and remains low.
Family Planning Perspectives. 1992 Sep-Oct; 24(5):235-6.Researchers analyzed data on 22,908 women obtained from randomized WHO studies from 23 countries to determine whether the IUD increases the risk of pelvic inflammatory disease (PID). 35% of the women used the TCu220C IUD, 39% other copper releasing IUDs, 16% a hormonal IUD, and 9% the Lippes Loop. The overall PID incidence rate was 0.4% of all IUD insertions or 1.6 cases/1000 woman years. The incidence was greatest during the 1st 20 days after insertion (9.7 cases/1000 women years) and then declined to 1.4/1000 woman years. In fact, the risk of PID was >6 times greater within 20 days after insertion than it was >20 days after insertion. This high risk immediately after insertion was evident in every region where PID existed, at all insertion times, and in all age groups. The higher risk within the 20 days after insertion was attributed to contamination of the uterus during insertion. Women who had an IUD inserted after 1980 experienced PID 50% less often than those who had had it inserted earlier, e.g., the rate ratio for 1977-80 was 1.5 but was 0.5 for 1981-83 and 0.34 for 1984 and after. This may have been due to physicians being more aware of contraindications for IUD use, particularly past infection with sexually transmitted diseases )STDs). The rate ratio was higher in Africa (2.6) than it was in Europe (1) but lower in Asia (0.46) and in the Americas (0.39). None of the subjects in China experienced PID. Older women were at lower risk of PID than 15-24 year olds (0.44 for 25-29 year olds, 0.38 for 30-34 year olds, and 0.35 for =or> 35 year olds). The researchers believed the higher risk life styles of the younger group accounted for this difference. Risk of PID decreased with family size (2.5 for 0 children, 0.56 for 2 children, and 0.39 for at least 4 children). The risk of PID did not differ with IUD type. The researchers concluded that the major determinant of PID is exposure to an STD rather than type of IUD.
FAMILY PLANNING WORLD. 1992 Jan-Feb; 2(1):31.Currently there are only 2 IUDs available in the US: the TCu380A, known to practitioners as the Copper T380A and commercially as Paragard, holds the largest share of the market. This IUD is a Copper bearing variety that has a recently doubled life span of 8 years. Its annual cost is less than $40, masking it the least expensive form of contraception available. The other IUD is called the Progestasert, or the Progesterone T to practitioners, is a T shaped IUD that holds a years supply of Progesterone. It must be removed annually to be refilled. Practitioners have used this to its advantage by scheduling annual gynecological exams to be performed along with the refill. Both cost about $300 with the Progestasert having the additional annual cost of refill. GynoPharma has developed a new IUD that is currently part of the largest IUD safety study ever conducted. The WHO is conducting a study that involves a sample of 6000 women. The device is called Flexigard 330 and the company plans to apply for approval with the FDA before then end of 1992.
Lancet. 1992 Mar 28; 339(8796):783-4.It is difficult to determine if the IUD increases the risk of pelvic inflammatory disease (PID) because simple clinical features are not consistently predictive and can have low specificity and sensitivity. The C-reactive protein and the erythrocyte sedimentation rate tests help with PID diagnosis, but only a laparoscopy can determine tubal involvement. In 1970, WHO's Cooperative Statistical Programme found 2-year combined PID rates to range from 3.8 to 5.2/100 women with an IUD. Then WHO and various US organizations agreed IUD use did not necessarily cause PID. During the 1970s, however, a large rise in sexually transmitted diseases (STDs), especially chlamydia and gonorrhea, occurred and were associated with PID incidence. Many believed the growing rate of PID was attributable to the increasing use of IUDs. Many studies were biased because of overdiagnosis of PID. A 1990 review of 28 articles revealed that the overall PID rate was 1.49/100 woman years (lower than what many believed earlier). Some researchers used multicountry data on 22, 908 IUD insertions from WHO's data base for IUD studies to determine PID risk in IUD users. This risk was somewhat high during the 1st 20 days postinsertion which may be related to insertion, but PID rates in IUD users corresponded with those from the general population. PID rates did increase with age, however, and they did vary with geographical area. In addition, rates were 62% lower in women whose IUD was inserted after 1980. The PID rate was associated with background risk of STDs. These results and those of other studies suggest that health staff must adequately assess all patients before fitting the IUD and insert it only under strict aseptic conditions. IUDs that release copper and levonorgestrel pose a lower risk of PID than nonmedicated IUDs.
SINGAPORE MEDICAL JOURNAL. 1989 Aug; 30(4):390-2.In the 1980s, a study showed an association between IUD use and pelvic inflammatory disease (PID) and subsequent infertility. About the same time, 2 major manufacturers of IUDs stopped making IUDs. These 2 events caused a decline in IUD use worldwide. In Singapore, however, the decline began in the 1960s when the Family Planning Board withdrew the IUD from its 5 year plan. After that, researchers in Singapore 1st conducted randomized prospective trials of most new IUDs. For example in the late 1980s, they began a prospective trial of the MLCu380 with a complicated insertion system. Multicenter trails have demonstrated that at least 5 of the newest copper IUDs have a failure rate of <2/100 woman years and <1/100 for 3 other new copper IUDs. Some manufacturers have increased the area of exposed copper from 200-250mm to 375-380mm to increase efficacy, but a prospective trial in Singapore did not show an increase. A large multicenter trial has shown that the levonorgestrel releasing IUD (LNg20) has a very low failure rate (.12/100) and reduces menstrual loss, unlike the copper IUDs. Due to legal concerns over the medical grade plastic, however, the manufacturer stopped distributing it in the late 1980s. WHO hoped to identify a manufacturer for the plastic so further trials could begin around 1991. In the late 1980s, WHO studied the silver cored copper wire IUD used to prevent fragmentation. Since IUDs change the endometrium which suppresses intrauterine pregnancies but not extrauterine pregnancies, the risk of an ectopic pregnancy is 10 times that of a nonuser. The risk is lower in copper IUDs suggesting that copper ions reduce the chance of fertilization in the Fallopian tubes. The risk of PID in IUD users ranges from 1.5-2.6. The majority of IUD associated PID occurs within 4 months following insertion and in nulliparous patients with several sexual partners.
A randomized comparative study of interval insertion of three intrauterine devices: the copper T 220c, the Nova T and the WHO levonorgestrel 2 ug IUD.
[Unpublished] 1985 May. 5 p. (Project: 82901)The objective is to compare the effectiveness and acceptability of 3 IUDs inserted in 300 health women, aged 24-38. All have had at least 1 full-term delivery. Subjects were randomly allocated to 1 of the 3 IUDS: the Copper T 220C (Tcu 220c), the Nova T, and the World Health Organization levonorgestrel 2 ug IUD. Insertion was done from the 3rd to the 5th day of menstruation between Feb. and Sept. 1984 and followed up at 48 hours, 3, 6, 12, and 24 months after IUD insertion. 12 month data was collected for cumulative rates, based on life table procedures and analyzed with log-rank test. There was no loss to follow up and no insertion failure. All levonorgestrel IUDs have been removed because the levonorgestrel-releasing IUD has a relatively high risk of ectopic pregnancy. The use-related discontinuation rates of Tcu 220c, Nova T, and levonorgestrel IUD during 12 months of use, were 11.1, 2.4, and 12.7, respectively. The difference between Tcu 220c and Nova T were statistically significant (p.<0.01). The continuation rates of Tcu 220c, Nova T, and levonorgestrel during 6 months of use were 94.0, 99.0, and 96.0, respectively. During 12 months of use, they were 88.9, 97.6, and 87.3 respectively. 1 ectopic pregnancy occurred with the levonorgestrel IUD after 7 months of use. No pregnancy occurred in Nova T users. The pregnancy rates of Tcu 220c and levonorgestrel IUD during 12 months of use were 1.0 and 1.3, respectively. Removal rates for bleeding with Tcu 220c and levonorgestrel IUD during 12 months of use were 3.1 and 1.0, respectively. The removal rate for pain with Tcu 220c during 12 months of use was 2.0. The duration of bleeding and spotting with 3 IUDs, 3, 6, 9, and 12 months of use are illustrated. Preliminary results show that the Nova T is superior to Tcu 220c and levonorgestrel IUDs. Expulsion is the main event in both Nova T and Tcu 220c. More attention should be paid to the insertion technique. The duration of bleeding and spotting of levonorgestrel IUD were longer in the last 3 months after insertion, but was shortest at 1 year of use when compared with Tcu 220c and Nova T.
In: Zatuchni GI, Goldsmith A, Shelton JD, Sciarra JJ, ed. Long-acting contraceptive delivery systems. Philadelphia, Pa., Harper and Row, 1984. 621-7. (PARFR Series on Fertility Regulation)Progestasert (Alza Corporation, Palo Alto, California) achieves relatively high rates of contraceptive effectiveness through the release of a sex hormone--progesterone. Currently, it is recommended that Progestaserts be replaces every 12 months and most copper-bearing IUDs, every 3 years. To improve on Progestasert's 1-year replacement interval, Alza Corporation modified the Progestasert by increasing the amount of pregesterone contained in the IUD (from 38 to 52 mg) without changing the average daily release of 65mg. This long-acting progestasert, called the Intrauterine Progesterone Contraceptive System (IPCS), was designed to have a useful life of 3 years before replacement was required. The IPCS is identical in appearance to the Progestasert, and its contraceptive action in the same as that of the Progestasert. The effectiveness of either is through the effects of an intrauterine foreign body and through the effects of the progesterone on the encometrium. The IPCS system was designed to provide maximum contraceptive protection over a 3-year period and to reduce IUD-related bleeding, pain, and expulsion problems. Results from Alza monitored trials of the IPCS in the US and Mexico indicate that the cumulative life-table pregnancy rate increased from 3.6/100 women after 25 to 30 months of use to 10.6/100 women after 30 to 36 months of use. Laboratory evaluations of removed IPCS devices indicates that after 30 months of IPCS use the release rate of progesterone may not be adequate to prevent pregnancy effectively. The World Health Organization (WHO) evaluated the IPCS in 2 multiclinic studies. Postinsertion complications and complaints for the IPCS and T Cu-200 are shown. The include cervical perforation, ectopic pregnancy, pelvic inflammatory disease, dysmenorrhea, bleeding, spotting, and pelvic pain. The IPCS seemingly offers no particular advantages for use in developing countries.
Personal communication. 1979 Mar 23; 12.Tables show total purchases direct from manufacturers, in quantities and dollar values, of IUDs, condoms, injectables, and spermicides, out of UNFPA, WHO, Population Council, IPPF, and UNICEF Funds for individuals years from 1974 to 1978 for 40 countries in Africa, Asia, and Latin America. Th 2 types of IUDs that were mainly purchased were the Lippes Loop and the CuT200, both of which are aggregated into a single figure. Figures are given both for total value of purchases, total amounts purchased, and reimbursable procurement.
In: Mishell, D.R., Jr., and Martinez-Manautou, J., eds. Clinical experience with the progesterone uterine therapeutic system. (Proceedings of the Acapulco Workshop, Acapulco, Mexico, October 15-16, 1976) Princeton, New Jersey, Excerpta Medica, 1978. p. 99-103In order to compare the efficacy and acceptability of the Progestasert progesterone-releasing IUD and the Gravigard Copper-7 device, 295 parous women randomly received the progesterone device (146) or the copper device (149). Follow-up examinations took place at 1, 3, 6, and 12 months postinsertion. It was found that event rates did not differ significantly between the progesterone (1569 women-months) and the copper (1558 woman-months) devices. Greater pain on insertion (23.3% versus 15.4%), less metrorrhagia (7.5% versus 13.4%), and higher continuation rates after 1 year of use (87.2% versus 84.6%) were associated with the progesterone device. A flow decrease of 27.2% and increase of more than 22.3% was associated with the Copper-7. Duration of menstruation was not significantly different between the 2 groups, but the progesterone IUD users had more days of "spotting." In both groups, duration of menstruation increased by the end of the study year for a large number of women. This was significant only in Copper-7 users.